Circumcision in the Media

November 30 2005
Rebecca Goldin

A one-sided account of a debatable medical procedure

The L.A. Times just got tough about circumcision. They cite a new study, published in Public Library of Science Medicine, showing that circumcised boys are less like to get the HIV virus than uncircumcised boys. From this, the L.A. Times leaps to the conclusion that all boys should be circumcised. As they put it, “Circumcision may protect against HIV infection, new studies suggest. But more parents are forgoing the surgery.” While lauding the benefits of circumcision and lamenting the declining circumcision rates in the United States, the Times is diverging from advice given by the American Academy of Pediatrics (APP). The APP currently maintains that there is no medical reason for all boys to undergo the procedure. And it is not changing its position because of this new HIV study.

The study was conducted in South Africa, where infection rates for HIV are high and increasing. Two groups of boys were randomly assigned to undergo, or not, circumcision. Those boys who underwent the surgery were less than half as likely to get the HIV virus. Such strong numbers are extremely important, and highly suggestive that, in an environment in which HIV infections are common, circumcision could play a preventative role.

So why didn’t the AAP change its tune? Doesn’t preventative medicine clearly dictate that all boys – and even adults who are still clinging to their foreskin – be circumcised as a matter of routine? Clearly, this is the suggestion given by the L.A. Times in quoting Robert Bailey, a lead author of the study “One of the benefits [circumcision] has is that it is permanent and protects every time."

The reason that doctors haven’t jumped is buried in the numbers. Numbers that the L.A. times didn’t bother to write about. The actual likelihood of any individual getting HIV in the United States is extremely low. The L.A. Times cites the statistic that there are 40,000 new HIV cases a year in the United States. However, they do not break that up into the categories of infection that might be affected by circumcision. The new infection rate includes babies get HIV from their mothers and teens get infections through sharing needles. Based on information published by the Center for Disease Control, STATS estimates that the number of new male infections due to unprotected sex is about 21,000 per year. And if we assume that the rate is halved if the men were circumcised (a conservative assumption, since many of the new infections are already circumcised men), we reduce new infections by about 11,000 per year by circumcising every male baby in the country. And there are more than 2,000,000 new baby boys born in the United States each year. That’s a lot of circumcisions for the benefit – a reduction of 5.5 HIV infections per 10,000 circumcisions.

While it is true that there are decreased rates of urinary tract infections, penile cancer, HIV, and some sexual transmitted diseases among circumcised boys and adults, all of these problems occur in an extremely small percentage of the population. Condoms and reduced exposure to others with the virus minimize the chance, while drug use and unprotected sex increase the risk. The L.A. Times’ recommendation would fare better in populations with high risk. This may include some cities and some subpopulations in the U.S., but does not mean the whole country. The current rate of HIV (not AIDS) infection in the United States is estimated at 136.7 per 100,000 people (CDC, 2004), or just over 1 person per 1,000.

With a lifelong-risk of under 0.15%, Americans are justified in making their decisions about circumcision independent of the possibility of HIV infection. Quite reasonably, parents who are reluctant to expose their children to the known risks of circumcision (most notably, infection, pain, scarring, and bleeding) may not feel that the reduced HIV risk is worth it.